AB1035 TRANSLATION AND CROSS-CULTURAL ADAPTATION OF THE ASAS HEALTH INDEX ENVIRONMENTAL FACTORS ITEM SET INTO SWEDISH AND ASSESSMENT OF RELIABILITY OF THE SWEDISH VERSIONS OF ASAS HEALTH INDEX AND ENVIRONMENTAL FACTORS ITEM SET
Authors: C. Feldthusen, M. Hallström, A. D’elia, A. Deminger, U. Kiltz, H. Forsblad-D’elia
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> The impact of axial spondyloarthritis (axSpA) on health-related quality of life can be substantial<sup>[1]</sup>, affecting both physical and mental health<sup>[2]</sup>. There is a need to assess the effect with disease-specific instruments. A global collaboration developed the Assessments of SpondyloArthritis international Society Health Index (ASAS HI) and Environmental Factors Item Set (EFIS). These instruments measure everyday function and health across aspects typical and relevant for patients with axSpA<sup>[3]</sup>. These instruments have been translated into 35 languages<sup>[4]</sup> but only the ASAS HI component has been translated into Swedish. <h3>Objectives</h3> To translate and culturally adapt EFIS into Swedish, and to assess reliability of the Swedish ASAS HI and EFIS. <h3>Methods</h3> Patients with axSpA were recruited from the rheumatology clinic at Sahlgrenska University Hospital, Sweden. ASAS HI and EFIS contain 17 and 9 items respectively, with dichotomous response options; "I agree" or "I do not agree". The total sum of ASAS HI ranges from 0 to 17, lower score indicating better health status. EFIS does not provide a sum score due to its multidimensional nature. Translation and cultural adaptation of EFIS was carried out using a forward–backward procedure consisting of: Initial translation; synthesis of the translations; back translation; expert committee review; field testing with cognitive debriefing<sup>[5]</sup>. The translations were performed separately by translators with clinical perspective and professional translators with no medical or clinical background. Reliability was analysed by internal consistency, evaluated with the Cronbach's alpha coefficient for ASAS-HI, and test-retest reliability using the intraclass correlation coefficient (ICC) for ASAS-HI (sum-score) and EFIS (discrete items). <h3>Results</h3> Ten patients were recruited to the field test and 61 patients to the reliability study of which 53 (87%) returned a second questionnaire after 1 week and were included in the test-retest reliability study (Table 1). <i>Translation and cross-cultural adaptation of the EFIS.</i> The translators produced a prefinal Swedish version of EFIS. The field test was performed in 10 patients and resulted in minor rewording. <i>Internal consistency.</i> ASAS HI scores showed an acceptable internal consistency; Cronbach's alpha 0.79. <i>Test-retest reliability.</i> ASAS HI sum score showed excellent reliability; ICC (95% CI) 0.87 (0.78-0.93), P-value &lt;0.001. ASAS EFIS individual items reliability ranged from poor for item 2, 3 and 8 to excellent for item 1 and 9; ICC (95% CI) from -0.43 (-0.83 to 0.41), P-value 0.56, to 0.89 (0.81 to 0.94), P-value &lt;0.01. <h3>Conclusion</h3> A Swedish version of EFIS has been produced and uploaded on ASAS website<sup>[4]</sup>. The Swedish version of ASAS-HI showed acceptable internal consistency and excellent test- retest reliability. Test-retest reliability for individual items of EFIS varied from poor to excellent. <h3>References</h3> [1]Ward MM. Health-related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis Care Res. 1999;12(4):247-255. [2]Law L, et al. Factors related to health-related quality of life in ankylosing spondylitis, overall and stratified by sex. Arthritis Res Ther. 2018;20(1):284. [3]Kiltz U, et al. Development of a health index in patients with ankylosing spondylitis (ASAS HI): final result of a global initiative based on the ICF guided by ASAS. Ann Rheum Dis. 2015;74(5):830-835. [4]www.asas-group.org/instruments/asas-health-index/ [5]Beaton DE, et al. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186-3191. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.